Abstract P88: Novel Tool Improves Cardiovascular Risk Stratification and Guides Therapy

Abstract

Background: Accurate risk assessment is of critical importance to any cardiovascular (CV) disease prevention program. Risk stratification tools enable providers to implement appropriate therapies. Objective: We sought to compare the performance of the Framingham Risk Score (FRS) with a CV Score previously validated by the Integrative Cardiac Health Project (ICHP) in a cohort of subjects with known subclinical atherosclerotic disease by abnormal carotid intima-media thickness (CIMT) measurement. Methods: Consecutive subjects (n=93) identified with subclinical atherosclerosis by abnormal CIMT (>75 th percentile by age/gender) were enrolled in a 6-month CV risk reduction program. Subjects were assessed for past medical history, family history of CV events, anthropometrics and a cardiac-relevant lab panel. FRS and ICHP CV Risk Score were calculated for each individual and were compared. The ICHP CV Risk Score incorporates additional factors such as family history of CV events as well as novel risk factors. All scores were categorized as low, medium and high for CV risk. Results: In 93 consecutive subjects, mean age was 53.1±11.13 yrs, 59% women, 47% African-American, 46% Caucasian, 3% Latina, 1% other. Diagnosis of diabetes was present in 13% of subjects. Means: BMI=31.2±5.3 kg/m 2 , WC=100.2±13.6 cm, fasting glc=99.1±35.9 mg/dL, insulin 15.6±14.4 ug/dL, Tchol=194.9±42.3 mg/dL, LDL 114.5±34.0 mg/dL, HDL 56.2±18.5 mg/dL, TG 117.3±66.3 mg/dL, Lp(a)=86.5±92.3 mg/dL, CRP 0.4±0.6 mg/dL. By FRS, 12 (14%) subjects scored high risk, 11 (12%) scored medium and 70 (75%) scored low risk. By ICHP CV Risk Score, 4 (36%) of the FRS medium upscored to high risk and 47 (67%) of the FRS low upscored to medium risk. In total, 63% upscored to an appropriately higher risk category by using the ICHP CV Risk Score. Conclusion: In a population with documented subclinical atherosclerosis and unremarkable conventional risk factor profiles, the ICHP CV Risk Score appeared to be more sensitive in identifying subjects at risk. The ICHP CV Risk Score may be a more discerning tool to guide risk reduction therapy in a prevention program.